191593695-7-24-2025-28-AS-LHIS-DKBNBK-20250807101916

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191593695
Report Date: 07/24/2025
Date Signed: 07/24/2025 01:26:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/18/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250718131615

FACILITY NAME:	CASA COLINA TLC/POST ACUTE BRAIN INJURY SERVICES		FACILITY NUMBER:	191593695
ADMINISTRATOR:	STEPHANIE KAPLAN		FACILITY TYPE:	775
ADDRESS:	255 EAST BONITA		TELEPHONE:	(909) 596-0955
CITY:	POMONA	STATE: CA	ZIP CODE:	91769
CAPACITY:	58	CENSUS: 46	DATE:	07/24/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rachel Tran - Director TLC PT Linda Levya - Director of Accreditation		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff member punched client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Rachel Tran, Director TLC Pysical Therapy and Linda Levya, Director of Accreditation and explained the reason for the visit.

The investigation consisted of the following: LPA conducted a tour of the physical plant, Transitional Living Center (Bldg #8), reviewed and obtained copies of the Client & Staff Rosters, Occupational Therapy Notes-Timeline of events (06/04/2025 - 06/09/2025), Abuse Reporting Checklist (06/04/2025), Internal notes meeting with S1 (dated 06/05/2025), Unusual Incident/Injury Report (SIR/06/09/2025)), LA County DPH inspection notes (07/22/2025) and LA Verne PD Police contact information (police # 250501648). LPA also obtained copies of Client #1 (C1) file such as: Identification/Emergency Information, Pre Admission Screening and Conditions of Admission (03/11/2025), Pre Placement Appraisal (03/11/2025), Physician's Report (04/24/2025), LPA interviewed Staff #1 (S1) - Staff #4 (S4) and Client #2 (C2) - Client #5 (C5). LPA attempted to interview Client #1 (C1) 3x but no response received.*****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250718131615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CASA COLINA TLC/POST ACUTE BRAIN INJURY SERVICES	FACILITY NUMBER: 191593695
	VISIT DATE: 07/24/2025

NARRATIVE

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The investigation revealed the following:

In regards to the allegation: "Staff member punched client in care." It is alleged that on
05/22/2025, C1 reported that S1 punched them in the stomach, which had caused them a lot of physical and emotional pain. No other information provided. All staff interviewed denied the allegation. According to S1, the community outing with C1 and other clients took place on 05/22/2025. When S1 and the clients returnedto the center, they reported that one of the clients was experiencing a behavioral episode, and they alsonoticed that C1's head was bowed the entire time, as if in a trance. Then, to get C1's attention, S1 tapped C1's right arm. S1 then said that C1 didn't seem to be in any pain, discomfort, or out of it. On 06/04/2025, W1 called S4 to report this incident filed by C1, during which C1 stated that S1 hit them on the chest. On the same day, S4 called C1 and FM1 multiple times, but no response received. On 06/05/2025, S2 met with S1 to conduct an internal investigation of this incident but S1 denied the allegation. On 07/17/2025, LA DPH representative also conducted an on site investigation but no deficiencies found. La Verne PD received a similar complaint from C1 on 07/23/2025 and spoke with the facility staff by phone, but no findings were made. (4) clients interviewed denied the allegation and all stated that they are satisfied with the staff and the therapy they are getting. Records reviewed by LPA revealed that there were no witnesses, photographs or video evidence of this incident. As a result, there was not enough evidence to support this allegation.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to Rachel Tran, Director of TLC Physical Therapy.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025

LIC9099 (FAS) - (06/04)

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